The October issue of Ultrasound in Obstetrics & Gynecology contains, among many other articles, a Systematic Review of the diagnostic accuracy of first-trimester ultrasound in the detection of fetal structural anomalies, an Original Article on the performance of color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE) in assessing the fetal heart, a study evaluating the performance of a previously developed first-trimester screening algorithm for pre-eclampsia in the population of the ASPRE trial, and a pilot study on the potential of MRI/ultrasound fusion imaging to identify Cesarean section scar.
Please see below a selection of articles from the October issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today.
First-trimester ultrasound for fetal structural anomalies
Fetal anomaly screening has traditionally been performed in the second trimester; however, recent advances in ultrasound technology have prompted re-assessment of the value of ultrasound in detecting fetal structural anomalies in the first trimester. In a systematic review of 26 studies, Karim et al. report on the diagnostic accuracy of ultrasound performed in the first-trimester in the detection of fetal structural anomalies in both low- and high-risk populations. Factors that may impact on detection rates were also evaluated.
Color and power Doppler combined with Fetal Intelligent Navigation Echocardiography (FINE)
Fetal Intelligent Navigation Echocardiography (FINE) is a method that automatically generates and displays nine standard fetal echocardiography views from volume datasets obtained with spatiotemporal image correlation (STIC). Thus far, only STIC volumes obtained via grayscale ultrasound could be analyzed using the FINE method; however, a recent technological advance now allows STIC volumes to be acquired in combination with color or bidirectional power Doppler information, so that fetal echocardiography views generated by FINE can be displayed with either modality. In this Original Article, Yeo and Romero evaluate the performance of color Doppler FINE in evaluating the heart of normal fetuses and those with congenital heart disease.
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Screening for preterm pre-eclampsia in the ASPRE trial population
The ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention) trial was a prospective first-trimester multicenter study on screening for preterm pre-eclampsia (PE) by means of an algorithm that combines maternal factors, mean arterial pressure, uterine artery pulsatility index, and maternal serum pregnancy-associated plasma protein-A and placental growth factor at 11–13 weeks' gestation. Women found to be at high-risk for PE were invited to participate in a double-blind trial of aspirin vs placebo from 11–14 weeks until 36 weeks’ gestation. In the aspirin group, the incidence of preterm PE was reduced by 62%. In this new study, Rolnik et al. assess the performance of the previously reported first-trimester algorithm for PE, developed from a study of approximately 60 000 singleton pregnancies, in the population of the ASPRE study. They found that the performance of screening was similar to that estimated from the original model, detecting 77% of cases of preterm PE and 43% of term PE at a FPR of 9%.
MRI/ultrasound fusion imaging for the assessment of Cesarean section scar
Women with a history of Cesarean section have a markedly higher risk of uterine rupture in future pregnancy. Evaluation of the Cesarean scar area is vital for the assessment of risk of uterine rupture during pregnancy, but identification of the scar area becomes increasingly difficult with advancement of the pregnancy. Image fusion of ultrasound with other imaging modalities allows for real-time navigation with synchronized side-by-side display and can offer many advantages for lesion detection, location and characterization. In this pilot study, Bolten et al. investigate whether fusion of transabdominal and transvaginal sonography with magnetic resonance imaging (MRI) allows standardized and reproducible identification of the scar location and measurement of uterine wall thickness compared with high-resolution MRI alone.
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Coming up in the next issue of UOG…
• An Editorial by Rolnik et al. on early screening and prevention of preterm pre-eclampsia with aspirin. Preview the accepted article.
• A systematic review on the outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to the umbilical artery Doppler flow pattern of the smaller twin. Preview the accepted article. This article has been chosen for Journal Club, so look out for the accompanying downloadable slides next month.